What is the scope of steroid use in the United States?

The 2005 Monitoring the Future study, a NIDA-funded survey of drug use among
adolescents in middle and high schools across the United States, reported that
past year use of steroids decreased significantly among 8th- and 10th-graders
since peak use in 2000. Among 12th-graders, there was a different trend—from
2000 to 2004, past year steroid use increased, but in 2005 there was a
significant decrease, from 2.5 percent to 1.5 percent.

Steroid abuse affects individuals of various ages. However, it is difficult
to estimate the true prevalence of steroid abuse in the United States because
many data sources that measure drug abuse do not include steroids. Scientific
evidence indicates that anabolic steroid abuse among athletes may range between
one and six percent.

Why do people abuse anabolic steroids?

One of the main reasons people give for abusing steroids is to improve their
athletic performance. Among athletes, steroid abuse has been estimated to be
less that 6 percent according to surveys, but anecdotal information suggests
more widespread abuse. Although testing procedures are now in place to deter
steroid abuse among professional and Olympic athletes, new designer drugs
constantly become available that can escape detection and put athletes willing
to cheat one step ahead of testing efforts. This dynamic, however, may be about
to shift if the saving of urine and blood samples for retesting at a future date
becomes the standard. The high probability of eventual detection of the newer
designer steroids, once the technology becomes available, plus the fear of
retroactive sanctions, should give athletes pause.

Another reason people give for taking steroids is to increase their muscle
size or to reduce their body fat. This group includes people suffering from the
behavioral syndrome called muscle dysmorphia, which causes them to have a
distorted image of their bodies. Men with muscle dysmorphia think that they look
small and weak, even if they are large and muscular. Similarly, women with this
condition think that they look fat and flabby, even though they are actually
lean and muscular.

Some people who abuse steroids to boost muscle size have experienced physical
or sexual abuse. In one series of interviews with male weightlifters, 25 percent
who abused steroids reported memories of childhood physical or sexual abuse.
Similarly, female weightlifters who had been raped were found to be twice as
likely to report use of anabolic steroids or another purported musclebuilding
drug, compared with those who had not been raped. Moreover, almost all of those
who had been raped reported that they markedly increased their bodybuilding
activities after the attack. They believed that being bigger and stronger would
discourage further attacks because men would find them either intimidating or
unattractive.

Finally, some adolescents abuse steroids as part of a pattern of high-risk
behaviors. These adolescents also take risks such as drinking and driving,
carrying a gun, driving a motorcycle without a helmet, and abusing other illicit
drugs. Conditions such as muscle dysmorphia, a history of physical or sexual
abuse, or a history of engaging in high-risk behaviors have all been associated
with an increased risk of initiating or continuing steroid abuse.